Detailed definition
Polycystic ovary syndrome (PCOS) is diagnosed by Rotterdam criteria — two of three: oligo-/anovulation, clinical or biochemical androgen excess, and polycystic ovarian morphology on ultrasound. Prevalence is 5–13% of reproductive-age women. PCOS is associated with insulin resistance, metabolic syndrome, type 2 diabetes, dyslipidemia, sleep apnea, and increased cardiovascular risk. Many features evolve through midlife: cycles often regularize as remaining oocyte reserve depletes, but metabolic and cardiovascular concerns continue. Postmenopausal women with PCOS history have higher rates of metabolic syndrome and cardiovascular events than women without. HRT decisions in this group should weigh the underlying cardiometabolic risk and prefer transdermal estradiol to avoid first-pass metabolic effects.
Why it matters in menopause
For women with PCOS history entering perimenopause, the overlap of PCOS metabolic features with menopausal weight and cardiovascular changes deserves attention. Standard HRT can be appropriate, with transdermal estradiol generally preferred over oral.